High-sensitivity C-reactive protein, plaque vulnerability and adverse events in patients with stable coronary disease: An optical coherence tomography study

Masahiro Katamine; Yoshiyasu Minami; Takako Nagata; Kiyoshi Asakura; Yusuke Muramatsu; Daisuke Kinoshita; Kazuhiro Fujiyoshi; Junya Ako

doi:10.1016/j.ijcard.2024.132924

High-sensitivity C-reactive protein, plaque vulnerability and adverse events in patients with stable coronary disease: An optical coherence tomography study

Int J Cardiol. 2024 Dec 22:421:132924. doi: 10.1016/j.ijcard.2024.132924. Online ahead of print.

Authors

Masahiro Katamine¹, Yoshiyasu Minami², Takako Nagata¹, Kiyoshi Asakura¹, Yusuke Muramatsu¹, Daisuke Kinoshita¹, Kazuhiro Fujiyoshi¹, Junya Ako¹

Affiliations

¹ Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
² Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan. Electronic address: nrg12391@yahoo.co.jp.

PMID: 39719217
DOI: 10.1016/j.ijcard.2024.132924

Abstract

Background: Higher levels of high-sensitivity C-reactive protein (hsCRP) are associated with increased risk of cardiovascular events in patients with coronary artery disease (CAD).

Aims: To elucidate the characteristics of coronary plaques in patients with CAD with high hsCRP levels.

Methods: A total of 793 consecutive patients with stable CAD who underwent optical coherence tomography (OCT) of the culprit vessel during percutaneous coronary intervention were included. Patients were classified into the higher hsCRP group (hsCRP ≥0.2 mg/dL, n = 247) or lower hsCRP group (hsCRP <0.2 mg/dL, n = 546). OCT characteristics and clinical outcomes were investigated according to hsCRP levels.

Results: The prevalence of thin-cap fibroatheroma (TCFA) (32.0 % vs. 20.9 %, p < 0.001) was significantly higher in the higher hsCRP group than in the lower hsCRP group. The incidence of myocardial infarction was significantly higher in the higher hsCRP group than in the lower hsCRP group (log-rank p = 0.006) during a median follow-up of 938 days, although the incidence of major adverse cardiac events was comparable (log-rank p = 0.282). Among the four groups classified by hsCRP level and the presence of TCFA, the incidence of myocardial infarction was highest in the group with both higher hsCRP levels and TCFA (log-rank p = 0.017).

Conclusions: Higher hsCRP levels were associated with a higher prevalence of vulnerable characteristics of coronary plaques and worse clinical outcomes in patients with stable CAD. The risk of recurrent myocardial infarction in patients with high hsCRP levels was further increased in the presence of TCFA.

Keywords: Coronary artery disease; High-sensitivity C-reactive protein; Macrophage; Optical coherence tomography; Thin-cap fibroatheroma.